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Tongue Tie (Ankyloglossia)

A common problem for babies is tongue tie, or lip tie. In these cases, the tissue that connects the tongue or lip to the rest of the mouth is short, tight, or otherwise unusual. Mild cases may go unnoticed, but more severe ones can cause problems with both breastfeeding and bottle feeding.


Anatomy of Tongue Tie

If you look in a mirror and lift your tongue to the roof of your mouth, you will see the frenulum. This is the stringy piece of tissue that connects your tongue to the base of your mouth. It stops your tongue from being too mobile. You will notice that a large portion of your tongue is not connected to the frenulum, allowing greater movement at the front of the tongue.

In tongue tie, the frenulum can be too short, or it may extend too far forward. Those that come too far forward may be easier to diagnose, and may cause the tongue to make a heart shape as illustrated above. When the baby cries, their tongue begins to raise, but the centre is held low. Similarly, you may notice that your baby is unable to stick their tongue out; some babies will mirror a parent who sticks their tongue out in the first few weeks of life, but not all babies who don’t mimic it have a tongue tie.

Lip Tie

Lip tie is discussed much less than tongue tie, but it can still cause an issue. In order for a baby to get a good latch on the breast or bottle, the lips need to flare outwards. This is quite dissimilar to how we drink from a bottle as an adult. If the baby’s lips are unable to turn outwards, they may compensate with higher sucking pressure, or clamp down with their jaws. Both can be painful if breastfeeding, or present problems of taking on air or fatiguing before full. These can lead to other gastric problems, like reflux or colicky symptoms.

Early Intervention

Of course, where tongue tie presents discomfort for mother or baby, immediate treatment would be ideal. The urgency is compounded by the nature of tongue tie surgery, should it be needed. The frenulum does not contain nerves that conduct sensation at birth. These develop during the first year, after which point surgery would be painful and warrant general anaesthetic. The procedure is much more simple where anaesthetic is not required. Therefore assessment and first line treatment should begin as soon as possible in case surgery is required.

The NHS recommends massage techniques as part of an early conservative treatment plan. Your paediatric osteopath is qualified to perform these techniques, and may be able to identify a suspected tongue tie or lip tie if you have been unable to get a diagnosis already. These techniques involve massaging and stretching the affected tissues with a gloved finger in baby’s mouth. They may protest, but the techniques are very gentle- just a surprise to them! You will be present throughout your baby’s appointment and we can stop or alter treatment at any point, just as we would with an adult.


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